To compensate for pain, suffering, and loss of land, the U.S. government:

Attempted to return Native tribes to their home regions.

Paid cash settlements.

Attempted to improve the Native Americans lives, and ended up almost erasing their Native Culture.

Currently, many Native Americans live on reservations or trust land designated by the federal government as well as in general society.

These lands are mere fractions of what was originally Indian territory.

Sovereign status was created through agreements with the federal government.

Native Americans and the U.S. Government continue to disagree about multiple issues including land holding and owed debts (La Crosse Medical Health Science Consortium, 2013).

Health services: A part of the treaty with the U.S. Government promised health care for life for Native American Indians. Currently, the U.S. Government issues monies in October which equals out to a little more than $2,000 per person, per year. The average American spends an average of $7,000 per person per year on health care (Arnold, Pine Ridge Cultural Orientation, 2013). Pine Ridge medical services are very limited. If the service needed is not provided at Pine Ridge, the individual must go "out of network" and use contracted dollars. Basically the individual has two options; wait for a contracted provider to come to Pine Ridge, or go without care/treatment. Global Partners helps to bridge this gap in care by providing specialized surgical care, along with medical evaluations, which helps the patient load for the regular doctors on Pine Ridge.

Population: "A 2005 study conducted by Colorado State University and accepted by the Federal Department of Housing and Urban Development estimates the resident population to be approximately 28,787. Jim Berg, Executive Director for Oglala Sioux Lakota Housing, states that the real number is closer to 40,000" (Red Cloud Indian School, 2013).

Language: English, Lakota (native language)

“It is estimated that there are 6,000 fluent speakers of the Lakota language today, according to The University of California-Los Angeles Language Materials Project. The study found the language is in severe danger of becoming extinct. In the early 1990s, about half of the population of the Pine Ridge Indian Reservation could speak the Lakota language. Today, that number has fallen to less than one-quarter on the Pine Ridge, and is as low as 4 percent on other Lakota reservations. Because the average fluent speaker is nearly 65 years old, it is estimated that the vast majority of current fluent speakers are first-language speakers. The rate of teaching second-language speakers is falling drastically behind” (Red Cloud School, 2013)

Economic realities

80% of residents are unemployed.

49% of residents live below the federal poverty line.

61% of residents below the age of 18 live below the poverty line.

The Pine Ridge Indian Reservation is located in Shannon County, where its per-capita income makes it the second poorest county in the United States, at $6,286.

If the Oglala Sioux Tribe were to equally disperse revenues from the Prairie Wind Casino to all enrolled tribal members, each resident would receive $.15 per month (Red Cloud School, 2013).

Health and Well-Being Realities

The infant mortality rate is five times higher than the United States national average.

More than 4.5 million cans of beers are sold annually in White Clay, Nebraska, just over the border from the Pine Ridge Indian Reservation. This amounts to more than 12,500 cans of beer a day. The reservation itself is dry.

Obesity, diabetes, and heart disease occur in epidemic proportions on the Pine Ridge.

Native Americans’ rate of amputations related to diabetes is three to four times higher than among the general United States population.

Death rates due to diabetes among Native Americans are three times higher than among the general United States population.

Unhealthy diets and lack of exercise are two main contributing factors behind these high numbers, despite the fact that in the early history of the Lakota, diabetes was virtually unknown.

Life expectancy on the Pine Ridge Indian Reservation is the lowest anywhere in the western hemisphere, except for Haiti. A recent study found the life expectancy for men to be 48 years, and for women it is 52 years (Red Cloud School, 2013).

Religion

Four Basic Tenets of Native American Spirituality (RE-MEMBER, 2013):

Recognition of the interconnectedness of creation and the responsibility of humans.

Belief that all life is equal and contains a spiritual meaning.

Primary concern with the long-term welfare of life - all life.

Spirituality is undergirded by thankfulness.

Native Americans believe that "everything is connected" (Kavanaugh et al, 1999), providing a strong relationship with the earth, animals, and each other. "There are members of the Native American Church, as well as Episcopalian, Presbyterian, Catholic, Body of Christ, and a wide variety of other belief systems. At times of crisis, prayers from all these groups are often welcome" (Iron Cloud & Bucko, 2008).

Seven Values of Lakota Life

Woc'ekiya – Praying: Finding spirituality by communicating with your higher power, this communication between you and Tunkasila without going through another person or spirit.

Wa o' hola – Respect: for self, higher power, family, community and all life.

Wa on'sila – Caring and Compassion: love caring, and concern for one another in a good way, especially for the family, the old ones, the young ones, the orphans, the one in mourning, the sick ones, and the ones working for the people.

Wowijke – Honesty and Truth: with yourself, higher power and others with sincerity.

Wawokiye – Generosity and Caring: helping without expecting anything in return, giving from the heart.

Wah'wala – Humility: we have a spirit; we are not better or less than others.

Woksape – Wisdom: practice with knowledge comes wisdom.

"They are hardy people, as their past attests, and are both proud of their traditions and optimistic about the future" (Kavanaugh et al, 1999). Cultural customs may vary greatly, even within the same community. Native Americans self-identify on a continuum ranging from "traditional," who ascribe to traditional practices, beliefs, and rituals to "Native," who have little knowledge or interest in traditional cultural practices (Krawcyzk, 2012). Native American culture is very proud and family centered. Extended family is usually present at doctors appointments and involved in decision making.

Needs Identified by the Community: In November, 2012, Global Partners sent a leadership team to Pine Ridge to meet with the Pine Ridge leadership to discuss the needs of the community. The needs discussed included a desire for diabetic education, suicide prevention, teen safety, and first aid (Pine Ridge Orientation, 2013). This continues to evolve.

Feelings toward healthcare: "Lakota people generally consult multiple healers, both Western and traditional, until relief for the problem is found. Lakota generally follow a particular healer, often someone who is related to them, but some will also change healers if they do not feel relief from their problems. There are few psychological services on the reservation, and worry about a lack of confidentiality undermines" (Iron Cloud & Bucko, 2008). Traditionally, Native Americans tend to value wellness as the harmony of body, mind and spirit and believe that attitude is most important in maintaining wellness (La Crosse Medical Health Science Consortium, 2013). Herbs, rituals, and other methods are used to promote physical wellness. Sweat lodges or other cleansing rituals are used for purification but can vary by tribe (La Crosse Medical Health Science Consortium, 2013). Western medicine may be accepted in addition to traditional methods; however, some Native American Indians may feel weary of hospitals and clinics. Some patients may have difficulty adapting to the series of questions asked by practitioners; it is best to try to build a relationship with the patient before delving into the medical history. Writing while the patient is speaking may be viewed as disrespectful and should be avoided if possible (La Crosse Medical Health Science Consortium, 2013).

Social Etiquette and Elastic Time: Sharing food is often a way of welcoming visitors, similar to a handshake (Krawczyk, 2012). "Native American people communicate a great deal through non-verbal gestures. For example, individuals may look down to show respect or a gentle handshake is seen as a sign of respect, not weakness" (Krawczyk, 2012). It is common for a Native American to convey a response to a question through storytelling rather than directly answering a question. Therefore, it is crucial to practice good listening skills and be aware of body language, as well as avoid interrupting (Krawczyk, 2012). Thank-you’s are generally implied and not directly stated (LMHSC, 2013).

An important aspect of Native American Culture is understanding 'elastic' time. The following excerpt is from the volunteer organization RE-MEMBER:

“Their understanding of time is different than ours. Our approach to time is quite regimented. Time exists to solve problems, to accomplish goals, and we surround ourselves with clocks, watches, calendars, date books, day planners, PDA’s and Blackberrys. We eat and sleep when the clock tells us it’s time. The Lakota understanding of time is that it exists at the pleasure of the individual and the community. It is more important to stay with an important human interaction than to hurry to an appointment. The focus is on the quality, rather than the quantity of time. Sleep is for when you’re tired; food for when you’re hungry. Our culture values accomplishing goals, where the Lakota culture values relationships. For us, relationships are often based on what that relationship will help us accomplish and our definitions of success tend to be based on objective, measurable standards. The Lakota relationship exists for the relationship, rather than what can be accomplished with it, and success is subjective and consequently, less important. 'Western' culture values reasoning and the ability to present a cogent (and winning) argument, while traditional Lakota decisions were reached more intuitively and through consensus. With them, the emphasis is on maintaining a relationship over accomplishing a goal. They have a high tolerance for ambiguity, where we prefer things to be clear cut, yes or no, problem solved and goal achieved. There is a strong emphasis in the dominant U.S. culture on honesty and clear and direct communication. We value following the rules and living up to expectations. In the Lakota culture the worst thing you can do is cause shame or dishonor to your family, your people, to another person. They prefer to approach conflict indirectly and confronting someone is considered rude and disrespectful” (RE-MEMBER).

Etiquette Do’s (Krawcyzk, 2012)

Learn how the community refers to itself as a group of people (e.g. Tribal name)

Be honest and clear about your role and expectations and be willing to adapt to meet needs of the community.

Show respect by being open to other ways of thinking and behavior.

Listen and observe more than you speak. Learn to be comfortable with silence or long pauses in conversation.

Avoid jargon. An AI/AN community member may nod their head politely but not understand what you are saying.

It is acceptable to admit limited knowledge of AI/AN culture and invite people to educate you about specific cultural protocols in their community.

If you are visiting the home of an AI/AN family, you may be offered a beverage and/or food, and it is important to accept it as a sign of respect.

Respect confidentiality and the right of the tribe to control information, data, and public information about services provided to the tribe.

Be open to allow things to proceed according to the idea that "things happen when they are suppose to happen."

"Respectful questions about customs are generally welcomed, but may not be answered directly."

Etiquette Don’ts

Avoid stereotyping based on looks, language, dress, and other outward appearances.

Avoid intrusive questions early in conversation.

Do not interrupt others during conversation or interject during pauses or long silences.

Be careful not to impose your personal values, morals, or beliefs.

Avoid frequently looking at your watch and do not rush things.

Avoid pressing all family members to participate in a formal interview.

Do not touch sacred items, such as medicine bags, other ceremonial items, hair, jewelry, and other personal or cultural things.

Do not take pictures without permission.

Reminders for successful communication:

Pay attention, listen, and pause before speaking.

Smile and laugh-if everything is serious you are viewed as untrustworthy.

Open mind, open heart (closed mouth).

"Things happen on Indian time" - not exactly the pace you might be used to.

Do not over promise and under deliver

Take Home Message:

Basic knowledge of a culture is helpful; however keep in mind that individuals may have different beliefs within that cultural group.

Dress modestly and appropriately.

Educate yourself on appropriate social etiquette in order to foster trusting relationships.

Resources

Books

The Scalpel and the Silver Bear: The First Navajo Woman Surgeon Combines Western Medicine and Traditional Healing by Alvord Arviso: A remarkable book that takes the reader on a spellbinding journey between two worlds; surgeon Lori Arviso Alvord describes her struggles to bring modern medicine to the Navajo reservation in Gallup, New Mexico-and to bring the values of her people to a medical care system in danger of losing its heart.

On the Rez by Ian Frazier: This book is about modern-day Native Americans, especially the storied Oglala Sioux, who live now on the Pine Ridge Indian Reservation in the plains and badlands of the American West. Frazier finds a modern reemergence of the Sioux hero who saves her people. Most of all, with compassion and imagination, Frazier brings you into the private world of the reservation. He portrays the survival, through toughness and humor, of a great people whose culture has shaped America's identity.

Black Elk Speaks by John Neihardt: This book was the result of a series of interviews between Nick Black Elk, an American Indian from a Sioux tribe, and John Neihardt, a white poet. Black Elk, a holy man who fought in the Indian wars of the late 1800s, struggled throughout his life with the firm belief that he was supposed to save his people from the encroachment of white settlers. Neihardt wrote the narrative, which is about Black Elk's early years, in the first person, as if the words were spoken by Black Elk himself. Neihardt also added information from his own research and included passages that are represented as the words of other American Indian leaders.

The Last Report on the Miracles at Little No Horse by Louise Erdrich: For more than a half century, Father Damien Modeste has served his beloved people, the Ojibwe, on the remote reservation of Little No Horse. Now, nearing the end of his life, Father Damien dreads the discovery of his physical identity, for he is a woman who has lived as a man. To complicate his fears, his quiet life changes when a troubled colleague comes to the reservation to investigate the life of the perplexing, difficult, possibly false saint Sister Leopolda. Father Damien alone knows the strange truth of Sister Leopolda's piety and is faced with the most difficult decision of his life: Should he reveal all he knows and risk everything? Or should he manufacture a protective history though he believes Leopolda's wonder-working is motivated by evil?

Bury My Heart at Wounded Knee by Dee Brown: Using council records, autobiographies, and firsthand descriptions, Brown allows great chiefs and warriors of the Dakota, Ute, Sioux, Cheyenne, and other tribes to tell us in their own words of the series of battles, massacres, and broken treaties that finally left their people demoralized and decimated. A unique and disturbing narrative told with force and clarity, Bury My Heart at Wounded Knee changed forever our vision of how the West was won, and lost. It tells a story that should not be forgotten, and so must be retold from time to time.

Movies

Chiefs: Wind River Indian Reservation (where the Northern Arapaho and Eastern Shoshone were confined by the U.S. government on 3,500 square miles of central Wyoming) is hardly an environment conducive to success. Poverty, alcoholism, racism and youth suicide are just a few of the challenges the cultures face. But despite all of this - or perhaps because of it - basketball is played on the reservation (rez) and played very well. Learn more about the movie.

Incident at Oglala: On June 26, 1975, during a period of high tensions on the Pine Ridge reservation in South Dakota, two FBI agents were killed in a shootout with a group of Indians. Although several men were charged with killing the agents, only one, Leonard Peltier, was found guilty. This film describes the events surrounding the shootout and suggests that Peltier was unjustly convicted.

Wounded Heart: Pine Ridge and the Sioux: American Indians and government officials discuss poverty, racism, domestic violence, child abuse, inadequate health care, and drug and alcohol problems that besiege the Pine Ridge Indian Reservation in southwest South Dakota.

Bury My Heart at Wounded Knee: HBO presents an epic movie event with executive producers Dick Wolf and Tom Thayer, based on Dee Brown's bestseller, Bury My Heart at Wounded Knee, which powerfully explores the tragic impact that the United States' westward expansion had on American Indian culture, and the economic, political and social pressures that motivated it.

Healers at Wounded Knee Video Series-Part 1 WXOW News 19 Daybreak anchor Amy DuPont and photographer Kirk Arneson chronicled a group of volunteers from Gundersen Health System as they traveled to the Pine Ridge Indian Reservation in South Dakota to help improve the quality of healthcare in one of the poorest areas in the country: